Healthcare Provider Details

I. General information

NPI: 1285279430
Provider Name (Legal Business Name): FLORIDA UROLOGY PARTNERS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S ARMENIA AVE
TAMPA FL
33609-4123
US

IV. Provider business mailing address

5015 W NASSAU ST
TAMPA FL
33607-3814
US

V. Phone/Fax

Practice location:
  • Phone: 813-353-8803
  • Fax: 813-353-8602
Mailing address:
  • Phone: 813-356-0196
  • Fax: 813-356-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MALCOM ROOT
Title or Position: PHYSICIAN/PARTNER
Credential: MD
Phone: 813-356-0196